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Is There a Common Ground?

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Is There a Common Ground? Affiliations Between Catholic and Non-Catholic Health Care Providers and the Availability of Reproductive Health Services Acknowledgements This project was commissioned by the Henry J. Kaiser Family Foundation, Menlo Park, California. We gratefully acknowledge this support and the assistance of our project officers, Suzanne Delbanco and Felicia Stewart. We would also like to thank the following individuals, who served as advisors to the project or provided consultation: Jeffrey Alexander, Carol Bayley, Rev. Dennis Brodeur, Patrick Hill, James Kaskie, Frances Kissling, Laurence J. O’Connell, Thomas R. Prince, and Sr. Carol Taylor. The views expressed in this report, however, are entirely the responsibility of the authors. Finally, we thank the administrators, clinicians, and board members at the participating case study sites. While we cannot disclose their names for reasons of confidentiality, we are grateful for their willingness to share time, information, and insights on behalf of this project. Kaiser Family Foundation iii Affiliations Between Catholic and Non-Catholic Health Care Providers and the Availability of Reproductive Health Services Executive Summary This project is concerned with affiliations between Catholic and non-Catholic health care providers and their impact on the availability of reproductive health services in communities. The project examines trends in affiliations involving Catholic health care organizations, key issues in the affiliation process, the role of reproductive health services in the affiliation process, the impact of affiliations on the availability of a range of reproductive health services, and approaches used to provide these services. The number and types of formal affiliations (including joint ventures, mergers, acquisitions, consolidations, and long-term lease agreements) involving Catholic health care organizations between 1990 and 1996 are described, and a comparative case study method is used to describe the affiliation process and its outcomes. The cases are intended as illustrative models of successfully negotiated affiliations between Catholic and non-Catholic organizations and of possible solutions to issues involving the availability of reproductive health services. The study finds that the number of affiliations between Catholic and non- Catholic health care organizations has been increasing (as have affiliations in the health care industry as a whole) and that a range of strategies is used to accommodate the partners’ different values and traditions. The case studies of four successfully negotiated affiliations between Catholic and non-Catholic health care organizations suggest that acknowledging the importance of ideological differences early in the affiliation process and developing explicit strategies to deal with controversial issues are critically important. Overall, the case studies reveal little change in the availability of reproductive health services as a result of affiliations. Surgical abortion was the service most likely to be curtailed post-affiliation, and obstetrical services were most likely to be expanded or improved. Specific findings are highlighted below. Overall Context for Affiliations · Catholic hospitals represent about 10% of U.S. acute-care hospitals and were involved in about 18% of the nation’s hospital affiliations between 1990 and 1996. Kaiser Family Foundation 1 Executive Summary · Between 1990 and 1996, 131 formal affiliations involving a Catholic hospital or health system were publicly reported, of which 78% were between Catholic and non-Catholic organizations. · Between 1990 and 1996, 40% of known affiliations between Catholic and non-Catholic providers were mergers, and 39% were acquisitions. · Key factors motivating affiliations between Catholic and non-Catholic organizations in four case studies were increased competition in local markets resulting from the growth of managed care and capitation, declining hospital census, and a desire to increase market share. Factors Associated with Completed Affiliations (in Case Studies) · Ethical and religious concerns about reproductive health services were evident in all case studies, and the reproductive service most often at issue in the affiliation process was abortion. · Successfully negotiated affiliations between Catholic and non-Catholic case study organizations were characterized by: ú identifying a strategy to address differences in ethical and religious values and their impact on controversial services early in the affiliation process; ú developing strategies to obtain necessary approvals from the Department of Justice and the Catholic Church; ú developing a plan for managing the operational and cultural changes required to support an affiliation, including human resources issues; ú developing a plan to motivate physicians’ participation in the affiliation process; and ú actively informing the community and soliciting community involvement in all phases of the affiliation process. · Ongoing challenges for the affiliation partners included managing cultural integration, workforce reduction, and physician-hospital relationships. · Benefits to the communities included avoiding closure of facilities, improved services, reduced health care costs, and expanded community-based health programs. 2 Kaiser Family Foundation Executive Summary Outcomes with Regard to Availability of Reproductive Health Services (in Case Studies) · Outcomes for reproductive health services were influenced by several factors: the pre-affiliation range of services provided by the partnering organizations, the history of earlier affiliation attempts, community involvement in the affiliation process, and community traditions with regard to women’s reproductive rights. · Hospital-based surgical abortion services were discontinued in two cases and unchanged in two cases; policies proscribing abortion referrals were not observed. · Obstetrical services were expanded in two cases and unchanged in two cases. · Family planning/contraceptive services were regarded before and after affiliations as issues best considered within individual physician-patient relationships. · Emergency contraception services were unchanged as a result of affiliations and were available either on-site or at local or regional rape crisis centers. · Sterilization services were expanded in one case and continued to be provided in the other cases. · Infertility services were unchanged in all cases. · Emerging issues related to reproductive health services in the case study sites include provision of non-surgical abortion, providing core benefits, and defining and providing comprehensive women’s health services. A key policy implication of this project is that assessing the potential impact on a community of affiliations between Catholic and non-Catholic health care organizations is complex. There is no simple correspondence between the type of affiliation and the outcomes with regard to availability of reproductive health services. Community members and policymakers need to weigh the potential benefits of affiliations (such as preserving community providers or enhancement of services) against the potential costs of affiliations (such as loss of proscribed services or added burdens to consumers seeking care). Kaiser Family Foundation 3 Affiliations Between Catholic and Non-Catholic Health Care Providers and the Availability of Reproductive Health Services I. Introduction A. Background and Context The purpose of this project is to examine the affiliation process between Catholic and non-Catholic health care providers and to assess the outcomes of affiliations for the availability of reproductive health services in the community. In the changing health care environment, there are increasing market pressures on hospitals and other health care organizations to form affiliations of various kinds. Often these organizations have different value orientations that may affect both the type of affiliation formed and the range of services made available to sociodemographically diverse communities. Catholic-sponsored hospitals have been increasingly involved in formal affiliations in recent years, and because Catholic values proscribe or constrain provision of certain reproductive services, some of these affiliations have attracted the attention of the media and advocacy groups concerned about the public’s access to these services. Because women are the major consumers of reproductive health services, women’s groups have been particularly concerned about these affiliations. This project considers how affiliation agreements are reached between Catholic and other health care organizations, the role of reproductive health services in forming these agreements, and the impact of these affiliations on the availability of reproductive health services in communities. Catholic hospitals comprise the largest component of religiously sponsored health care organizations in the United States. In 1995, there were approximately 600 Catholic hospitals (about 10% of all U.S. acute-care hospitals), accounting for approximately 14% of all acute-care hospital beds (Japsen 1995a). The 1995 American Hospital Association Guide reports 62 Catholic multihospital systems with 487 hospitals operating over 112,000 beds; these hospitals comprised 83% of all hospitals in church-related systems, 34% of all hospitals in not-for-profit systems, and 17% of all system hospitals nationwide. The largest non-Catholic religious systems include Adventist and Baptist systems. Catholic health care facilities
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